Bupa Hospital Covers
WHAT YOU
NEED TO
KNOW AT
A GLANCE
Contents
Retail hospital covers at a glance
3
Corporate hospital covers at a glance
18
Visitors hospital covers at a glance
22
New Bupa membership cards
28
Bupa International membership cards
29
Pre-authorisation hospital checks for Bupa International members
31
This guide is for the use of hospital staff and providers only and does not contain
all product information. Detailed product information can be found at:
www.bupa.com.au/info for retail hospital covers
www.bupa.com.au/corporate-info for corporate hospital covers
www.bupa.com.au/visitors-info for visitors hospital covers
www.bupa.com.au/oshc-info for student hospital covers
Please also note this guide is subject to change without notice.
2
Effective APRIL 2014
RETAIL Hospital Covers at a Glance
This guide is for the use of hospital staff and providers only and does not contain all product information.
Please also note this guide is subject to change without notice.
Hospital
Cover
Active Saver (packaged)
Advantage Hospital $1,000 Excess
& Hospital Value $1,000 Excess*
ON SALE Product
off SALE Product
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees —
only for accidents requiring urgent medical attention and the
services included below. All other services that are not excluded
receive Minimum Benefits for shared room accommodation.
Public Hospitals: For Accidents requiring urgent medical
attention and the services listed below shared room benefit plus
a fixed benefit for a private overnight room. All other services
that are not excluded receive shared room minimum benefits.
Nil benefit for excluded services.
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees
except for Minimum Benefit and Excluded services.
Public Hospitals: Shared room minimum benefits plus a fixed
benefit for a private overnight room. Private room benefit not
applicable for minimum benefit services. Nil benefit for excluded
services.
Inclusions:
•Knee arthroscopy and meniscectomy procedures
•Appendicitis
•Removal of tonsils and adenoids
•Dental surgery
•Minor gynaecological surgery (not including laparoscopy)
Excess
N/A
$1000 per hospital admission (including same day and public
hospital admissions).
Capped each calendar year at once per adult when amount
has been met in full.
The excess does not apply to any child dependant covered
on the membership.
The excess does not apply on admissions for services with
a minimum benefit or for approved hospital ambulatory
programs or psychiatric and rehabilitation day programs
in private hospitals only.
Excess will apply for all overnight and day services in a public
hospital.
Co-Payment
$100 a day (including same day and public hospital admissions),
up to a maximum of $500 per hospital stay.
N/A
The co-payment does not apply on admissions for services with
a minimum benefit, approved hospital ambulatory programs or
psychiatric and rehabilitation day programs in private hospitals
only.
The co-payment will apply for all overnight and day services
in a public hospital.
MINIMUM
Benefits
(Share room
minimum benefits)
Exclusions
(No benefits apply)
Waiting
Periods
For the duration of this cover:
For the duration of this cover:
•All services other than the services listed above and exclusions
pay minimum benefits
•Surgical podiatry procedures
•Surgical podiatry procedures
For the duration of this cover:
For the duration of this cover:
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Cosmetic surgery that is not clinically required
•Cosmetic surgery that is not clinically required
•2 month initial, palliative care, psychiatric and rehabilitation
services
•2 month initial, palliative care, psychiatric and rehabilitation
services
•12 months pre-existing condition
•12 months pre-existing condition
•12 months pregnancy (including childbirth)
•12 months pregnancy (including childbirth)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only.
Excess applies to in-patients only.
Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services.
This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs.
Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List.
A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected]
*Hospital Value $1000 Excess was renamed Advantage Hospital $1000 Excess effective 1 April 2012.
3
Effective APRIL 2014
RETAIL Hospital Covers at a Glance
Hospital
Cover
Excess
BUDGET FAMILY COVER (packaged)
BUDGET HOSPITAL & HOSPITAL
SELECT VALUE* $250 & $500 EXCESS
ON SALE Product
ON SALE Product
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees for
services that are not Minimum Benefit or Excluded services.
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees for
services that are not Minimum Benefit or Excluded services.
Public Hospitals: Shared room minimum benefit plus a fixed
benefit for a private overnight room. Private room benefit
not applicable for minimum benefits services. Nil benefit for
excluded services.
Public Hospitals: Shared room minimum benefit plus a fixed
benefit for a private overnight room. Private room benefit
not applicable for minimum benefits services. Nil benefit for
excluded services.
$250 or $500 per hospital admission (including same day and
public admissions).
$250 or $500 per hospital admission (including same day and
public admissions).
Capped each calendar year at once per adult when amount has
been met in full.
Capped each calendar year at once per person, twice per
couples or family membership when amount has been met
in full.
The excess does not apply to any child dependant covered on
the membership.
The excess does not apply on admissions for services with
a minimum benefit, approved hospital ambulatory programs or
psychiatric and rehabilitation day programs in private hospitals
only.
Excess will apply for all overnight and day services in a public
hospital.
Co-Payment
MINIMUM
Benefits
(Share room
minimum benefits)
The excess does not apply on admissions for services with
a minimum benefit, approved hospital ambulatory programs or
psychiatric and rehabilitation day programs in private hospitals
only.
Excess will apply for all overnight and day services in a public
hospital.
N/A
N/A
For the duration of this cover:
For the duration of this cover:
• Pregnancy (including childbirth)
•Pregnancy (including childbirth)
• IVF and assisted reproductive services
•IVF and assisted reproductive services
• Cataract and eye lens procedures
•Cataract and eye lens procedures
• Hip and knee replacements including arthroplasty, revisions
and resurfacing procedures
•Hip and knee replacements including arthroplasty, revisions
and resurfacing procedures
• Dialysis for chronic renal failure
•Dialysis for chronic renal failure #
• Psychiatric services
•Psychiatric services
• Surgical podiatry procedures
•Gastric banding and all obesity related treatment
•Surgical podiatry procedures
#
EXCLUSIONS
(No benefits apply)
Waiting
Periods
ialysis only attracts minimum benefits if the member joined on or after
D
1 April 2006
For the duration of this cover:
For the duration of this cover:
• Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
• Cosmetic surgery that is not clinically required
•Cosmetic surgery that is not clinically required
• 2 month initial, palliative care, psychiatric and rehabilitation
services
•2 month initial, palliative care, psychiatric and rehabilitation
services
• 12 months pre-existing condition
•12 months pre-existing condition
• 12 months pregnancy (including childbirth)
•12 months pregnancy (including childbirth)
• N o waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only.
Excess applies to in-patients only.
Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services.
This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs.
Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List.
A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected]
*Hospital Select Value $250 & $500 Excess was renamed Budget Hospital $250 & $500 Excess effective 1 April delete.
4
Effective APRIL 2014
RETAIL Hospital Covers at a Glance
Hospital
Cover
Budget Hospital & Hospital
Select Value $1,000 Excess*
Choices (PACKAGED)
off SALE Product
ON SALE Product
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees for
services that are not Minimum Benefit or Excluded services.
Public Hospitals: Shared room minimum benefits plus a fixed
benefit per day for private overnight room. Private room benefit
not applicable for minimum benefit services. Nil benefit for
excluded services.
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees —
only for accidents requiring urgent medical attention and the
services included below. All other services that are not excluded
receive Minimum Benefits for shared room accommodation.
Public Hospitals: For Accidents requiring urgent medical
attention and the services listed below shared room benefit plus
a fixed benefit for a private overnight room. All other services
that are not excluded receive shared room minimum benefits.
Nil benefit for excluded services.
Inclusions:
•Knee arthroscopy and meniscectomy procedures
•Appendicitis
•Removal of tonsils and adenoids
•Dental surgery
•Ankle arthroscopy and ankle ligament repair
•Shoulder arthroscopy and selected minor shoulder procedures
Excess
$1000 per hospital admission (including same day and public
admissions).
$250 per hospital admission (including same day and public
admissions).
Capped each calendar year at once per person, twice per
couples or family membership when amount has been met
in full.
Capped each calendar year at once per person, twice per
couples membership when amount has been met in full.
The excess does not apply on admissions for services with
a minimum benefit, approved hospital ambulatory programs or
psychiatric and rehabilitation day programs in private hospitals
only.
Excess will apply for all overnight and day services in a public
hospital.
Co-Payment
MINIMUM
Benefits
(Share room
minimum benefits)
Exclusions
(No benefits apply)
The excess does not apply on admissions for services with
a minimum benefit, approved hospital ambulatory programs or
psychiatric and rehabilitation day programs in private hospitals
only.
Excess will apply for all overnight and day services in a public
hospital.
N/A
N/A
For the duration of this cover:
For the duration of this cover:
•Psychiatric services
•Surgical podiatry procedures
•All services other than the services listed above and exclusions
pay minimum benefits
For the duration of this cover:
For the duration of this cover:
•Cardiac and cardiac-related services
•Cardiac and cardiac-related services
•Pregnancy (including childbirth)
•Pregnancy (including childbirth)
•Surgical podiatry procedures
•IVF and assisted reproductive services
•IVF and assisted reproductive services
•Cataract and eye lens procedures
•Cataract and eye lens procedures
•All joint replacements including arthroplasty revisions and
resurfacing procedures
•All joint replacements including arthroplasty, revisions and
resurfacing procedures
•Dialysis for chronic renal failure #
•Dialysis for chronic renal failure
•Gastric banding and all obesity related treatment
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Cosmetic surgery that is not clinically required
•Cosmetic surgery that is not clinically required
#
Waiting
Periods
Dialysis is an exclusion if the member joined on or after 1 April 2006
•2 month initial, palliative care, psychiatric and rehabilitation
services
•2 month initial, palliative care, psychiatric and rehabilitation
services
•12 months pre-existing condition
•12 months pre-existing condition
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only.
Excess applies to in-patients only.
Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services.
This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs.
Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List.
A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected]
*Hospital Select Value $1000 Excess was renamed Budget Hospital $1000 Excess effective 1 April 2012.
5
Effective APRIL 2014
RETAIL Hospital Covers at a Glance
Hospital
Cover
Established Family cover
Family Essentials
ON SALE Product
ON SALE Product
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees for
services that are not Minimum Benefit or Excluded services.
Public Hospitals: Shared room minimum benefit plus a fixed
benefit per day for private overnight room. Private room benefit
not applicable for minimum benefit services. Nil benefit for
excluded services.
Members First & Network Hospitals
Children: Cover for hospital accommodation, theatre fees at
shared room (ie: no private add on payable) and ICU, except for
minimum benefit or excluded services. Nil benefit for excluded
services.
Adults: For accidents requiring urgent medical attention full
cover for hospital accommodation at shared room (ie no private
room add on payable) and theatre fees except for minimum
benefit or excluded services. All other services that are not
excluded receive share room minimum benefits only. Nil benefit
for excluded services.
Public Hospitals: All services that are not excluded receive
shared room minimum benefits. Nil benefit for excluded services.
Excess
$250 or $500 per hospital admission (including same day and
public admissions).
N/A
Capped each calendar year at once per adult when amount has
been met in full.
The excess does not apply to any child dependant covered on
the membership.
The excess does not apply on admissions for services with a
minimum benefit or for approved hospital ambulatory programs
or psychiatric and rehabilitation day programs in private
hospitals only.
Excess will apply for all overnight and day services in a public
hospital.
Co-Payment
MINIMUM
Benefits
(Share room
minimum benefits)
N/A
N/A
For the duration of this cover:
For the duration of this cover:
• Pregnancy (including childbirth)
•Surgical podiatry procedures
• IVF and assisted reproductive services
• Cataract and eye lens procedures
• Surgical podiatry procedures
Exclusions
(No benefits apply)
Waiting
Periods
For the duration of this cover:
For the duration of this cover:
• Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
• Cosmetic surgery that is not clinically required
•Cosmetic surgery that is not clinically required
• 2 month initial, palliative care, psychiatric and rehabilitation
services
•2 month initial, palliative care, psychiatric and rehabilitation
services
• 12 months pre-existing condition
•12 months pre-existing condition
• 12 months pregnancy (including childbirth)
•12 months pregnancy (including childbirth)
• N o waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only.
Excess applies to in-patients only.
Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services.
This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs.
Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List.
A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected]
6
Effective APRIL 2014
RETAIL Hospital Covers at a Glance
Hospital
Cover
Excess
Family First (PACKAGED)
Growing FAMILY COVER (packaged)
OFF SALE Product
ON SALE Product
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees
except for Minimum Benefit and Excluded services.
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees for
services that are not Minimum Benefit or Excluded services.
Public Hospitals: Shared room Minimum Benefit plus a fixed
benefit per day for private overnight room. Private room benefit
not applicable for minimum benefit services. Nil benefit for
excluded services.
Public Hospitals: Shared room Minimum Benefit plus a fixed
benefit per day for private overnight room. Private room benefit
not applicable for minimum benefit services. Nil benefit for
excluded services.
$250, $500, or $1000 per hospital admission (including same
day and public admissions).
$250 or $500 per hospital admission (including same day and
public admissions).
Capped each calendar year at once per person, twice per
couples or family membership when amount has been met
in full.
Capped each calendar year at once per adult when amount has
been met in full.
The excess does not apply to any child dependant covered on
the membership.
The excess does not apply on admissions for services with a
minimum benefit or for approved hospital ambulatory programs
or psychiatric and rehabilitation day programs in private
hospitals only.
Excess will apply for all overnight and day services in a public
hospital.
Co-Payment
$50 a day (including same day and public admissions), up to a
maximum of $250 per hospital stay.
The excess does not apply to any child dependant covered on
the membership.
The excess does not apply on admissions for services with a
minimum benefit or for approved hospital ambulatory programs
or psychiatric and rehabilitation day programs in private
hospitals only.
Excess will apply for all overnight and day services in a public
hospital.
N/A
A co-payment does not apply to any child dependant covered
on the membership. The co-payment does not apply on
admissions for services with a minimum benefit or for approved
hospital ambulatory programs or psychiatric and rehabilitation
day programs in private hospitals only.
The co-payment will apply for all overnight and day services
in a public hospital.
MINIMUM
Benefits
(Share room
minimum benefits)
For the duration of this cover:
For the duration of this cover:
•Surgical podiatry procedures
• IVF and assisted reproductive services
• Cataract and eye lens procedures
• Hip and knee replacements including arthroplasty, revisions
and resurfacing procedures
• Dialysis for chronic renal failure
• Surgical podiatry procedures
Exclusions
(No benefits apply)
Waiting
Periods
For the duration of this cover:
For the duration of this cover:
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
• Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Cosmetic surgery that is not clinically required
• Cosmetic surgery that is not clinically required
•2 month initial, palliative care, psychiatric and rehabilitation
services
• 2 month initial, palliative care, psychiatric and rehabilitation
services
•12 months pre-existing condition
• 12 months pre-existing condition
•12 months pregnancy (including childbirth)
• 12 months pregnancy (including childbirth)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
• N o waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only.
Excess applies to in-patients only.
Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services.
This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs.
Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List.
A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected]
7
Effective APRIL 2014
RETAIL Hospital Covers at a Glance
Hospital
Cover
Excess
Co-Payment
HealthSmart Diamond (PACKAGED)
HealthSmart Gold (PACKAGED)
OFF SALE Product
OFF SALE Product
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees
except for Minimum Benefit and Excluded services.
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees
except for Minimum Benefit and Excluded services.
Public Hospitals: Shared room Minimum Benefit plus a fixed
benefit per day for private overnight room. Private room benefit
not applicable for minimum benefit services. Nil benefit for
excluded services.
Public Hospitals: Shared room Minimum Benefit plus a fixed
benefit per day for private overnight room. Private room benefit
not applicable for minimum benefit services. Nil benefit for
excluded services.
$250, $500, or $1000 per hospital admission (including same
day and public admissions).
$250, $500, or $1000 per hospital admission (including same
day and public admissions).
Capped each calendar year at once per person, twice per couple
or family membership when amount has been met in full.
Capped each calendar year at once per person, twice per couple
or family membership when amount has been met in full.
The excess does not apply on admissions for services with a
minimum benefit or for approved hospital ambulatory programs
or psychiatric and rehabilitation day programs in private
hospitals only.
The excess does not apply on admissions for services with a
minimum benefit or for approved hospital ambulatory programs
or psychiatric and rehabilitation day programs in private
hospitals only.
Excess will apply for all overnight and day services in a public
hospital.
Excess will apply for all overnight and day services in a public
hospital.
$50 a day (including same day and public admissions), up to a
maximum of $250 per hospital stay.
N/A
The co-payment does not apply on admissions for services
with a minimum benefit or for approved hospital ambulatory
programs or psychiatric and rehabilitation day programs in
private hospitals only.
The co-payment will apply for all overnight and day services
in a public hospital.
MINIMUM
Benefits
For the duration of this cover:
For the duration of this cover:
•Surgical podiatry procedures
•Surgical podiatry procedures
Exclusions
For the duration of this cover:
For the duration of this cover:
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Cosmetic surgery that is not clinically required
•Cosmetic surgery that is not clinically required
•2 month initial, palliative care, psychiatric and rehabilitation
services
•2 month initial, palliative care, psychiatric and rehabilitation
services
•12 months pre-existing condition
•12 months pre-existing condition
•12 months pregnancy (including childbirth)
•12 months pregnancy (including childbirth)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
(Share room
minimum benefits)
(No benefits apply)
Waiting
Periods
Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only.
Excess applies to in-patients only.
Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services.
This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs.
Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List.
A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected]
8
Effective APRIL 2014
RETAIL Hospital Covers at a Glance
Hospital
Cover
Excess
HealthSmart (packaged)
Hospital Cover
with Excess Bonus*
OFF SALE Product
OFF SALE Product
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees for
services that are not Minimum Benefit or Excluded services.
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees
except for Minimum Benefit and Excluded services.
Public Hospitals: Shared room Minimum Benefit plus a fixed
benefit per day for private overnight room. Private room benefit
not applicable for minimum benefit services. Nil benefit for
excluded services.
Public Hospitals: Shared room Minimum Benefit plus a fixed
benefit per day for private overnight room. Private room benefit
not applicable for minimum benefit services. Nil benefit for
excluded services.
$250, $500, or $1000 per hospital admission (including same
day and public admissions).
$250 per hospital admission from 1 April 2013 (including same
day and public admissions).
Capped each calendar year at once per person, twice per
couples membership when amount is met in full.
From 1 April 2013 capped each calendar year at once per adult
when amount is met in full.
The excess does not apply on admissions for services with a
minimum benefit or for approved hospital ambulatory programs
or psychiatric and rehabilitation day programs in private
hospitals only.
The excess will not apply to any child dependant covered on the
membership.
Excess will apply for all overnight and day services in a public
hospital.
The excess does not apply on admissions for services with a
minimum benefit or for approved hospital ambulatory programs
or psychiatric and rehabilitation day programs in private
hospitals only.
Excess will apply for all overnight and day services in a public
hospital.
Excess Bonus: One excess-free overnight or same-day admission
for single or single parent membership and two for a couple or
family membership per calendar year (ceasing 1 June 2013).
However, existing dollar amounts under the previous Excess
Bonus dollar scheme may be used towards any additional
excess.
Co-Payment
MINIMUM
Benefits
(Share room
minimum benefits)
Exclusions
(No benefits apply)
N/A
N/A
For the duration of this cover:
For the duration of this cover:
•Surgical podiatry procedures
•Surgical podiatry procedures
•Gastric banding and all obesity related services (applies from
1 June 2014)
For the duration of this cover:
For the duration of this cover:
•Pregnancy (including childbirth)
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•IVF and assisted reproductive services
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Cosmetic surgery that is not clinically required
•Cosmetic surgery that is not clinically required
Waiting
Periods
•2 month initial, palliative care, psychiatric and rehabilitation
services
•2 month initial, palliative care, psychiatric and rehabilitation
services
•12 months pre-existing condition
•12 months pre-existing condition
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
•12 months pregnancy (including childbirth)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only.
Excess applies to in-patients only.
Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services.
This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs.
Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List.
A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected]
*H ospital Cover with Excess Bonus was renamed Top Hospital Cover $250 Excess from 1 June 2013.
9
Effective APRIL 2014
RETAIL Hospital Covers at a Glance
Hospital
Cover
Excess
Hospital Cover
with Excess Bonus Plus
Hospital Cover with excess*
(LEVEL 4)
OFF SALE Product
OFF SALE Product
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees
except for Minimum Benefit and Excluded services.
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees
except for Minimum Benefit and Excluded services.
Public Hospitals: Shared room Minimum Benefit plus a fixed
benefit per day for private overnight room. Private room benefit
not applicable for minimum benefit services. Nil benefit for
excluded services.
Public Hospitals: Shared room Minimum Benefit plus a fixed
benefit per day for private overnight room. Private room benefit
not applicable for minimum benefit services. Nil benefit for
excluded services.
$200 per hospital admission (including same day and public
admissions).
$400 per hospital admission (including same day and public
admissions).
From 1 April 2013 capped each calendar year at once per adult
when amount is met in full.
From 1 April 2013 capped each calendar year at once per adult
when amount is met in full.
The excess will not apply to any child dependant covered on the
membership.
The excess will not apply to any child dependant covered on the
membership.
The excess does not apply on admissions for services with a
minimum benefit or for approved hospital ambulatory programs
or psychiatric and rehabilitation day programs in private hospitals
only.
The excess does not apply on admissions for services with a
minimum benefit or for approved hospital ambulatory programs
or psychiatric and rehabilitation day programs in private
hospitals only.
Excess will apply for all overnight and day services in a public
hospital.
Excess will apply for all overnight and day services in a public
hospital.
Excess Bonus: One excess-free overnight or same-day admission
for single or single parent membership and two for a family
membership per calendar year (ceasing 1 June 2013).
However, existing dollar amounts under the previous Excess
Bonus dollar scheme may be used towards any additional
excess.
Co-Payment
N/A
N/A
MINIMUM
Benefits
For the duration of this cover:
For the duration of this cover:
•Surgical podiatry procedures
•Surgical podiatry procedures
Exclusions
For the duration of this cover:
For the duration of this cover:
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Cosmetic surgery that is not clinically required
•Cosmetic surgery that is not clinically required
•2 month initial, palliative care, psychiatric and rehabilitation
services
•2 month initial, palliative care, psychiatric and rehabilitation
services
•12 months pre-existing condition
•12 months pre-existing condition
•12 months pregnancy (including childbirth)
•12 months pregnancy (including childbirth)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
(Share room
minimum benefits)
(No benefits apply)
Waiting
Periods
Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only.
Excess applies to in-patients only.
Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services.
This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs.
Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List.
A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected]
*Hospital Cover with Excess Level 5 was renamed Top Hospital $500 Excess effective 1 April 2013. Refer to Top Hospital Cover for details.
10
Effective APRIL 2014
RETAIL Hospital Covers at a Glance
Hospital
Cover
Excess
Co-Payment
Hospital ECONOMY COVER
Hospital ECONOMY Cover
with Excess Bonus
OFF SALE Product
OFF SALE Product
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees
except for Minimum Benefit and Excluded services.
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees
except for Minimum Benefit and Excluded services.
Public Hospitals: Shared room Minimum Benefit plus a fixed
benefit per day for private overnight room. Private room benefit
not applicable for minimum benefit services. Nil benefit for
excluded services.
Public Hospitals: Shared room Minimum Benefit plus a fixed
benefit per day for private overnight room. Private room benefit
not applicable for minimum benefit services. Nil benefit for
excluded services.
$400 per hospital admission (including same day and public
admissions).
$400 per hospital admission (including same day and public
admissions).
From 1 April 2013 capped each calendar year at once per adult
when amount is met in full.
From 1 April 2013 capped each calendar year at once per adult
when amount is met in full.
The excess will not apply to any child dependant covered on
the membership.
The excess will not apply to any child dependant covered on
the membership.
The excess does not apply on admissions for services with a
minimum benefit or for approved hospital ambulatory programs
or psychiatric and rehabilitation day programs in private
hospitals only.
The excess does not apply on admissions for services with a
minimum benefit or for approved hospital ambulatory programs
or psychiatric and rehabilitation day programs in private
hospitals only.
Excess will apply for all overnight and day services in a public
hospital.
Excess will apply for all overnight and day services in a public
hospital.
Excess Bonus Dollars: Existing dollar amounts under the
previous Excess Bonus dollar scheme may be used towards
any excess.
Excess Bonus Dollars: Existing dollar amounts under the
previous Excess Bonus dollar scheme may be used towards
any excess.
$40 a day (including same day and public admissions), up to
a maximum of $200 per hospital stay.
N/A
From 1 April 2013 the co-payment will not apply to any child
dependant covered on the membership.
The co-payment does not apply on admissions for services
with a minimum benefit or for approved hospital ambulatory
programs or psychiatric and rehabilitation day programs in
private hospitals only.
The co-payment will apply for all overnight and day services
in a public hospital
MINIMUM
Benefits
For the duration of this cover:
For the duration of this cover:
•Surgical podiatry procedures
•Surgical podiatry procedures
Exclusions
For the duration of this cover:
For the duration of this cover:
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Cosmetic surgery that is not clinically required
•Cosmetic surgery that is not clinically required
•2 month initial, palliative care, psychiatric and rehabilitation
services
•2 month initial, palliative care, psychiatric and rehabilitation
services
•12 months pre-existing condition
•12 months pre-existing condition
•12 months pregnancy (including childbirth)
•12 months pregnancy (including childbirth)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
(Share room
minimum benefits)
(No benefits apply)
Waiting
Periods
Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only.
Excess applies to in-patients only.
Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services.
This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs.
Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List.
A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected]
11
Effective APRIL 2014
RETAIL Hospital Covers at a Glance
Hospital
Cover
Excess
Hospital Saver*
Hospital Saver Plus*
OFF SALE Product
OFF SALE Product
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees for
services that are not Minimum Benefit or Excluded services.
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees for
services that are not Minimum Benefit or Excluded services.
Public Hospitals: Shared room Minimum Benefit plus a fixed
benefit per day for private overnight room. Private room benefit
not applicable for minimum benefit services. Nil benefit for
excluded services.
Public Hospitals: Shared room Minimum Benefit plus a fixed
benefit per day for private overnight room. Private room benefit
not applicable for minimum benefit services. Nil benefit for
excluded services.
$500 per hospital admission (including same day and public
admissions).
Hospital Saver Plus had 5 levels to choose from:
Capped each calendar year at once per person, twice per couple
or family membership when met in full.
•Level 2 – (refer to Standard Hospital $250)
The excess does not apply on admissions for services with
a minimum benefit, approved hospital ambulatory programs
or psychiatric and rehabilitation day programs in private
hospitals only.
Excess will apply for all overnight and day services in a public
hospital.
•Nil excess
•Level 3 – (refer to Standard Hospital $250)
•Level 4 – $400
•Level 5 – (refer to Standard Hospital $500)
The excess is paid per hospital admission (including same day
and public admissions).
From 1 April 2013 capped each calendar year at once per adult
when amount is met in full.
The excess will not apply to any child dependent covered on
the membership.
The excess does not apply on admissions for services with a
minimum benefit or for approved hospital ambulatory programs
or psychiatric and rehabilitation day programs in private
hospitals only.
Excess will apply for all overnight and day services in a public
hospital.
Co-Payment
MINIMUM
Benefits
(Share room
minimum benefits)
N/A
N/A
For the duration of this cover:
For the duration of this cover:
•Cataract and eye lens procedures
•Cataract and eye lens procedures
•Hip and knee replacements including arthroplasty, revisions
and resurfacing procedures
•Hip and knee replacement including arthroplastry, revisions
and resurfacing procedures
•Pregnancy (including childbirth)
•IVF and assisted reproductive services (from 1 June 2013) #
•IVF and assisted reproductive services
•Dialysis for chronic renal failure
•Psychiatric services
•Surgical podiatry procedures
•Gastric banding and all obesity related treatment
•Dialysis for chronic renal failure
•Surgical podiatry procedures
Exclusions
(No benefits apply)
Waiting
Periods
#T
his change does not apply to the Nil Excess level. For all other levels:
Members who have served waiting periods will continue to be covered
for IVF and assisted reproductive services until 31 December 2013.
For the duration of this cover:
For the duration of this cover:
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Cosmetic surgery that is not clinically required
•Cosmetic surgery that is not clinically required
•2 month initial, palliative care, psychiatric and rehabilitation
services
•2 month initial, palliative care, psychiatric and rehabilitation
services
•12 months pre-existing condition
•12 months pre-existing condition
•12 months pregnancy (including childbirth)
•12 months pregnancy (including childbirth)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only.
Excess applies to in-patients only.
Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services.
This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs.
Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List.
A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected]
*H ospital
H ospital
Hospital
Hospital
12
Saver
Saver
Saver
Saver
is now Budget Hospital $500 excess.
Plus Level 2 was renamed Standard Hospital $250 Excess effective 1 June 2013.
Plus Level 5 was renamed Standard Hospital $500 Excess effective 1 April 2013.
Plus Level 3 will be renamed Standard Hospital $250 Excess effective 1 April 2014.
Effective APRIL 2014
RETAIL Hospital Covers at a Glance
Hospital
Cover
LIVE WELL
Public Hospital
ON SALE PRODUCT (from 1 April 2013)
OFF SALE Product
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees for
services that are not Minimum Benefit or Excluded services.
All hospitals: Minimum Benefits for shared room accommodation
only. Excluded Services receive no benefits.
Public Hospitals: Shared room Minimum Benefit plus a fixed
benefit per day for private overnight room. Private room benefit
not applicable for minimum benefit services. Nil benefit for
excluded services.
Excess
Nil, $250 and $500 options. Applies per hospital admission
including same day and public admissions.
N/A
Capped each calendar year at once per person, twice per
couples membership when amount has been paid in full.
The excess does not apply on admissions for services with a
minimum benefit or for approved hospital ambulatory programs
or psychiatric and rehabilitation day programs in private
hospitals only.
Excess will apply for all overnight and day services in a public
hospital.
Co-Payment
MINIMUM
Benefits
(Share room
minimum benefits)
N/A
N/A
For the duration of this cover:
For the duration of this cover:
• Pregnancy (including childbirth)
•All services when in private hospitals
• IVF and assisted reproductive services
•Surgical podiatry procedures
• Dialysis for chronic renal failure
• Gastric banding and all obesity related treatment
• Surgical podiatry procedures
Exclusions
(No benefits apply)
Waiting
Periods
For the duration of this cover:
For the duration of this cover:
• Procedures not recognised by Medicare or not approved
by the Medical Services Advisory Committee and
experimental treatment
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
• Cosmetic surgery that is not clinically required
•Cosmetic surgery that is not clinically required
• 2 month initial, palliative care, psychiatric and rehabilitation
services
•2 month initial, palliative care, psychiatric and rehabilitation
services
• 12 months pre-existing condition
•12 months pre-existing condition
• 12 months pregnancy (including childbirth)
•12 months pregnancy (including childbirth)
• N o waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only.
Excess applies to in-patients only.
Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services.
This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs.
Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List.
A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected]
13
Effective APRIL 2014
RETAIL Hospital Covers at a Glance
Hospital
Cover
Singles Choice Saver (packaged)
Standard HOSPITAL & HOSPITAL SELECT PLUS $250 & $500
EXCESS*
OFF SALE Product
ON SALE Product
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees —
only for accidents requiring urgent medical attention and the
services included below. All other services that are not excluded
receive Minimum Benefits for share room accommodation.
Public Hospitals: For Accidents requiring urgent medical
attention and the services listed below shared room benefit plus
a fixed benefit for a private overnight room. All other services
that are not excluded receive shared room minimum benefits.
Nil benefit for excluded services.
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees for
services that are not Minimum Benefit or Excluded services.
Public Hospitals: Shared room Minimum Benefit plus a fixed
benefit per day for private overnight room. Private room benefit
not applicable for minimum benefit services. Nil benefit for
excluded services.
Inclusions:
• Knee arthroscopy and meniscectomy procedures
• Appendicitis
• Removal of tonsils and adenoids
• Dental surgery
• Minor gynaecological surgery (not including laparoscopy)
Excess
N/A
$250 or $500 per hospital admission (including same day and
public admissions).
Capped each calendar year at once per adult when amount is
met in full.
The excess does not apply to any child dependant covered on
the membership.
The excess does not apply on admissions for services with a
minimum benefit or for approved hospital ambulatory programs
or psychiatric and rehabilitation day programs in private
hospitals only.
Excess will apply for all overnight and day services in a public
hospital.
Co-Payment
MINIMUM
Benefits
(Share room
minimum benefits)
N/A
N/A
For the duration of this cover:
For the duration of this cover:
•All services other than the services listed above and exclusions
pay minimum benefits
•Cataract and eye lens procedures
•Surgical podiatry procedures
•Hip and knee replacements including arthroplasty, revisions
and resurfacing procedures
•Dialysis for chronic renal failure #
•IVF and assisted reproductive services
•Surgical podiatry procedures
#
Exclusions
(No benefits apply)
Waiting
Periods
ialysis only attracts minimum benefits if the member joined on or after
D
1 April 2006
For the duration of this cover:
For the duration of this cover:
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Cosmetic surgery that is not clinically required
•Cosmetic surgery that is not clinically required
•2 month initial, palliative care, psychiatric and rehabilitation
services
•2 month initial, palliative care, psychiatric and rehabilitation
services
•12 months pre-existing condition
•12 months pre-existing condition
•12 months pregnancy (including childbirth)
•12 months pregnancy (including childbirth)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only.
Excess applies to in-patients only.
Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services.
This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs.
Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List.
A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected]
*H ospital
Hospital
Hospital
Hospital
14
Select Plus $250 & $500 Excess was renamed Standard Hospital $250 & $500 Excess effective 1 April 2013.
Saver Plus Level 2 was renamed Standard Hospital $250 Excess effective 1 June 2013.
Saver Plus Level 5 was renamed Standard Hospital $500 Excess effective 1 April 2013.
Saver Plus Level 3 will be renamed Standard Hospital $250 Excess effective 1 April 2014.
Effective APRIL 2014
RETAIL Hospital Covers at a Glance
Hospital
Cover
Excess
Standard Hospital $1,000 EXCESS
& HOSPITAL SELECT PLUS $1000 EXCESS*
Start n Save
OFF SALE Product
OFF SALE Product
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees for
services that are not Minimum Benefit or Excluded services.
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees
except for Minimum Benefit and Excluded services.
Public Hospitals: Shared room Minimum Benefit plus a fixed
benefit per day for private overnight room. Private room benefit
not applicable for minimum benefit services. Nil benefit for
excluded services.
Public Hospitals: Shared room Minimum Benefit plus a fixed
benefit per day for private overnight room. Private room benefit
not applicable for minimum benefit services. Nil benefit for
excluded services.
$1000 per hospital admission (including same day and public
admissions).
$500 per hospital admission (including same day and public
admissions).
Capped each calendar year at once per person, twice per
couples or family membership when amount has been met
in full.
Capped each calendar year at once per adult when amount has
been met in full.
The excess does not apply on admissions for services with a
minimum benefit or for approved hospital ambulatory programs
or psychiatric and rehabilitation day programs in private
hospitals only.
Excess will apply for all overnight and day services in a public
hospital.
The excess does not apply to any child dependant on the
membership.
The excess does not apply on admissions for services with a
minimum benefit or for approved hospital ambulatory programs
or psychiatric and rehabilitation day programs in private
hospitals only.
Excess will apply for all overnight and day services in a public
hospital.
Excess Bonus Dollars: Existing dollar amounts under the
previous Excess Bonus dollar scheme may be used towards any
additional excess.
Co-Payment
N/A
$50 a day (including same day and public admissions), up to
a maximum of $250 per hospital stay.
The co-payment does not apply to any child dependant on
the membership.
The co-payment does not apply on admissions for services
with a minimum benefit or for approved hospital ambulatory
programs or psychiatric and rehabilitation day programs in
private hospitals only.
The co-payment will apply for all overnight and day services
in a public hospital
MINIMUM
Benefits
For the duration of this cover:
For the duration of this cover:
•Surgical podiatry procedures
•Surgical podiatry procedures
Exclusions
For the duration of this cover:
For the duration of this cover:
•Cataract and eye lens procedures
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
(Share room
minimum benefits)
(No benefits apply)
•All joint replacements including arthroplasty, revisions and
resurfacing procedures
•IVF and assisted reproductive services
•Dialysis for chronic renal failure
•Cosmetic surgery that is not clinically required
#
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Cosmetic surgery that is not clinically required
#
Waiting
Periods
ialysis only attracts minimum benefits if the member joined on or after
D
1 April 2006
•2 month initial, palliative care, psychiatric and rehabilitation
services
•2 month initial, palliative care, psychiatric and rehabilitation
services
•12 months pre-existing condition
•12 months pre-existing condition
•12 months pregnancy (including childbirth)
•12 months pregnancy (including childbirth)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only.
Excess applies to in-patients only.
Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services.
This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs.
Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List.
A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected]
*Hospital Select Plus $1000 Excess was renamed Standard Hospital $1000 Excess effective 1 April 2012.
15
Effective APRIL 2014
RETAIL Hospital Covers at a Glance
Hospital
Cover
Top Hospital Cover (NOW Incorporating Advantage
Hospital, Hospital Plus, Hospital Value, HOSPITAL
SUPER PLUS, HOSPITAL COVER EXCESS LEVEL 5 & Premium
Hospital)*
Ultimate Health Cover (packaged)
ON SALE Product
ON SALE Product
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees
except for Minimum Benefit and Excluded services.
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees
except for Minimum Benefit and Excluded services.
Public Hospitals: Shared room minimum benefit plus a fixed
benefit per day for a private overnight room. All other services
that are not excluded receive shared room minimum benefits.
Nil benefit for excluded services.
Public Hospitals: Shared room minimum benefit plus a fixed
benefit per day for a private overnight room. All other services
that are not excluded receive shared room minimum benefits.
Nil benefit for excluded services.
In addition this product covers laser eye procedures used to
adjust the eyeball to correct sight (excludes laser procedures
involving lens implants). Only at Bupa approved centres.
Ultimate Health Cover members charged a fixed daily fee by any
of our contracted fixed fee hospitals will be reimbursed or have
the fee paid directly to the hospital.
Excess
For the excess options: $250 or $500 per hospital admission
(including same day and public admissions).
N/A
Capped each calendar year at once per adult when amount has
been met in full.
The excess does not apply to any child dependant covered on
the membership.
The excess does not apply on admissions for services with a
minimum benefit or for approved hospital ambulatory programs
or psychiatric and rehabilitation day programs in private
hospitals only.
Excess will apply for all overnight and day services in a public
hospital.
Co-Payment
For the co-payment option: $50 a day (including same day and
public admissions), up to a maximum of $250 per hospital stay.
N/A
The co-payment does not apply to child dependants on the
membership.
The co-payment does not apply on admissions for services
with a minimum benefit or for approved hospital ambulatory
programs or psychiatric and rehabilitation day programs in
private hospitals only.
The co-payment will apply for all overnight and day services
in a public hospital
MINIMUM
Benefits
For the duration of this cover:
For the duration of this cover:
•Surgical podiatry procedures
•Surgical podiatry procedures
Exclusions
For the duration of this cover:
For the duration of this cover:
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Cosmetic surgery that is not clinically required
•Cosmetic surgery that is not clinically required
•2 month initial, palliative care, psychiatric and rehabilitation
services
•2 month initial, palliative care, psychiatric and rehabilitation
services
•12 months pre-existing condition
•12 months pre-existing condition
•12 months pregnancy (including childbirth)
•12 months pregnancy (including childbirth)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
•1 year laser eye correction (excludes lens implant for eye
correction)
(Share room
minimum benefits)
(No benefits apply)
Waiting
Periods
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only.
Excess applies to in-patients only.
Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services.
This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs.
Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List.
A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected]
Ultimate members attending a fixed fee service will have this charge paid directly to the hospital or reimbursed.
* Top Hospital Cover has 4 levels:
• Top Hospital Cover — no excess or co-payment (includes previously named Premium Hospital & Hospital Super Plus)
• Top Hospital Cover with Co-payment (includes previously named Advantage Hospital with Co-payment & Hospital Plus)
• Top Hospital Cover with $250 Excess (includes previously named Advantage Hospital $250 Excess, Hospital Value $250 Excess and Hospital Cover with Excess Bonus)
• Top Hospital Cover with $500 Excess (includes previously named Advantage Hospital $500 Excess, Hospital Value $500 Excess and Hospital Cover with Excess Level 5)
16
Effective APRIL 2014
RETAIL Hospital Covers at a Glance
Hospital
Cover
Young Singles/Couples Choice (packaged)
Young Singles/COUPLES
Saver (packaged)
ON SALE Product
ON SALE Product
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees for
services that are not Minimum Benefit or Excluded services.
Public Hospitals: Shared room minimum benefit plus a fixed
benefit per day for a private overnight room. All other services
that are not excluded receive shared room minimum benefits.
Nil benefit for excluded services.
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees —
only for accidents requiring urgent medical attention and the
services included below. All other services that are not excluded
receive Minimum Benefits for shared room accommodation.
Public Hospitals: For Accidents requiring urgent medical
attention and the services listed below shared room benefit plus
a fixed benefit for a private overnight room. All other services
that are not excluded receive shared room minimum benefits.
Nil benefit for excluded services.
Inclusions:
• Knee arthroscopy and meniscectomy procedures
• Appendicitis
• Removal of tonsils and adenoids
• Dental surgery
• Minor gynaecological surgery (not including laparoscopy)
Excess
Co-Payment
MINIMUM
Benefits
(Share room
minimum benefits)
N/A
N/A
$50 a day (including same day and public admissions), up to a
maximum of $250 per hospital stay.
$50 a day (including same day and public admissions), up to
a maximum of $250 per hospital stay.
The co-payment does not apply on admissions for services with
a minimum benefit, approved hospital ambulatory programs or
psychiatric and rehabilitation day programs in private hospitals
only.
The co-payment does not apply on admissions for services with
a minimum benefit, approved hospital ambulatory programs or
psychiatric and rehabilitation day programs in private hospitals
only.
The co-payment will apply for all overnight and day services
in a public hospital.
The co-payment will apply for all overnight and day services
in a public hospital.
For the duration of this cover:
For the duration of this cover:
•Cardiac and cardiac-related services
•All services other than the services listed above and exclusions
pay minimum benefits
•Pregnancy (including childbirth)
•IVF and assisted reproductive services
•Surgical podiatry procedures
•Cataract and eye lens procedures
•Hip and knee replacements including arthroplasty, revisions
and resurfacing procedures
•Psychiatric services
•Gastric banding and all obesity related treatment
•Dialysis for chronic renal failure
•Rehabilitation services
•Surgical podiatry procedures
Exclusions
(No benefits apply)
Waiting
Periods
For the duration of this cover:
For the duration of this cover:
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Cosmetic surgery that is not clinically required
•Cosmetic surgery that is not clinically required
•2 month initial, palliative care, psychiatric and rehabilitation
services
•2 month initial, palliative care, psychiatric and rehabilitation
services
•12 months pre-existing condition
•12 months pre-existing condition
•12 months pregnancy (including childbirth)
•12 months pregnancy (including childbirth)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only.
Excess applies to in-patients only.
Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services.
This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs.
Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List.
A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected]
17
Effective APRIL 2014
CORPORATE Hospital Covers at a Glance
This guide is for the use of hospital staff and providers only and does not contain all product information.
Please also note this guide is subject to change without notice.
Hospital
Cover
Excess
Co-Payment
MINIMUM
Benefits
(Share room
minimum benefits)
Corporate Hospital Cover
Corporate Hospital Intermediate
ON SALE Product
ON SALE Product
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees
except for Minimum Benefit and Excluded services.
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees for
services that are not Minimum Benefit or Excluded services.
Public Hospitals: Shared room minimum benefit plus a fixed
benefit per day for a private overnight room. All other services
that are not excluded receive shared room minimum benefits.
Nil benefit for excluded services.
Public Hospitals: Shared room minimum benefit plus a fixed
benefit per day for a private overnight room. All other services
that are not excluded receive shared room minimum benefits.
Nil benefit for excluded services.
•Level 1 – Nil Excess
•Level 1 – Nil Excess
•Level 2 – $250 per hospital admission for adults
•Level 2 – $250 per hospital admission for adults
•Level 3 – $500 per hospital admission for adults
•Level 3 – $500 per hospital admission for adults
Excess payable on same day and public admissions.
Excess payable on same day and public admissions.
Capped each calendar year at once per adult when amount has
been met in full.
Capped each calendar year at once per adult when amount has
been met in full.
The excess does not apply to any child dependant covered on
the membership.
The excess does not apply to any child dependant covered on
the membership.
The excess does not apply on admissions for services with a
minimum benefit or for approved hospital ambulatory programs
or psychiatric and rehabilitation day programs in private
hospitals only.
The excess does not apply on admissions for services with a
minimum benefit or for approved hospital ambulatory programs
or psychiatric and rehabilitation day programs in private
hospitals only.
Excess will apply for all overnight and day services in a public
hospital.
Excess will apply for all overnight and day services in a public
hospital.
N/A
N/A
For the duration of this cover:
For the duration of this cover:
•Surgical podiatry procedures
•Hip and knee replacement including revisions and resurfacing
procedures
•Cataract and eye lens procedures
•Surgical podiatry procedures
•IVF & assisted reproductive services (effective from 1st June
2014) #
#
Exclusions
(No benefits apply)
Waiting
Periods
embers who have served waiting periods will continue to be covered for
M
IVF and assisted reproductive services until 31 December 2014. Conditions
apply, contact Bupa for eligibility.
For the duration of this cover:
For the duration of this cover:
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Cosmetic surgery that is not clinically required
•Cosmetic surgery that is not clinically required
•2 month initial, palliative care, psychiatric and rehabilitation
services
•2 month initial, palliative care, psychiatric and rehabilitation
services
•12 months pre-existing condition
•12 months pre-existing condition
•12 months pregnancy (including childbirth)
•12 months pregnancy (including childbirth)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only.
Excess applies to in-patients only.
Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services.
This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs.
Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List.
A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected]
18
Effective APRIL 2014
CORPORATE Hospital Covers at a Glance
Hospital
Cover
Excess
Co-Payment
MINIMUM
Benefits
(Share room
minimum benefits)
Corporate Hospital Saver
Corporate Hospital Top
ON SALE Product
ON SALE Product
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees for
services that are not Minimum Benefit or Excluded services.
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees
except for Minimum Benefit and Excluded services.
Public Hospitals: Shared room minimum benefit plus a fixed
benefit per day for a private overnight room. All other services
that are not excluded receive shared room minimum benefits.
Nil benefit for excluded services.
Public Hospitals: Shared room minimum benefit plus a fixed
benefit per day for a private overnight room. All other services
that are not excluded receive shared room minimum benefits.
Nil benefit for excluded services.
•Level 1 – Nil Excess
•Level 1 – Nil Excess
•Level 2 – $250 per hospital admission
•Level 2 – $250 per hospital admission for adults
•Level 3 – $500 per hospital admission
•Level 3 – $500 per hospital admission for adults
Excess payable on same day and public admissions.
Excess payable on same day and public admissions.
Capped each calendar year at once per person, twice per
couples or family membership when amount has been met
in full.
Capped each calendar year at once per adult when amount
has been met in full. The excess does not apply to any child
dependant covered on the membership.
The excess does not apply on admissions for services with
a minimum benefit, approved hospital ambulatory programs
or psychiatric and rehabilitation day programs in private
hospitals only.
The excess does not apply on admissions for services with a
minimum benefit or for approved hospital ambulatory programs
or psychiatric and rehabilitation day programs in private
hospitals only.
Excess will apply for all overnight and day services in a public
hospital.
Excess will apply for all overnight and day services in a public
hospital.
N/A
N/A
For the duration of this cover:
For the duration of this cover:
•Psychiatric services
•Surgical podiatry procedures
•Pregnancy (including childbirth)
•IVF and assisted reproductive services
•Cataract and eye lens procedures
•Hip and knee replacements including revisions and resurfacing
procedures
•Gastric banding & all obesity related treatment (effective
1 June 2014)
•Surgical podiatry procedures
Exclusions
(No benefits apply)
Waiting
Periods
For the duration of this cover:
For the duration of this cover:
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Cosmetic surgery that is not clinically required
•Cosmetic surgery that is not clinically required
•2 month initial, palliative care, psychiatric and rehabilitation
services
•2 month initial, palliative care, psychiatric and rehabilitation
services
•12 months pre-existing condition
•12 months pre-existing condition
•12 months pregnancy (including childbirth)
•12 months pregnancy (including childbirth)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only.
Excess applies to in-patients only.
Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services.
This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs.
Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List.
A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected]
19
Effective APRIL 2014
CORPORATE Hospital Covers at a Glance
Hospital
Cover
Excess
HealthLink Advantage/
Classic/Essentials Plus
HealthLink Hospital
ON SALE Product
ON SALE Product
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees for
services that are not Minimum Benefit or Excluded services.
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees for
services that are not Minimum Benefit or Excluded services.
Public Hospitals: Shared room minimum benefit plus a fixed
benefit per day for a private overnight room. All other services
that are not excluded receive shared room minimum benefits.
Nil benefit for excluded services.
Public Hospitals: Shared room minimum benefit plus a fixed
benefit per day for a private overnight room. All other services
that are not excluded receive shared room minimum benefits.
Nil benefit for excluded services.
$0, $250, $500, or $1000 capped at once per person, twice
per membership per calendar year when amount has been met
in full.
$0, $250, $500, or $1000 capped at once per person, twice
per membership per calendar year when amount has been met
in full.
Excess payable on same day and public admissions.
Excess payable on same day and public admissions.
No excess for any child dependant on HealthLink Advantage only.
The excess does not apply on admissions for services with a
minimum benefit or for approved hospital ambulatory programs
or psychiatric and rehabilitation day programs in private
hospitals only.
The excess does not apply on admissions for services with a
minimum benefit or for approved hospital ambulatory programs
or psychiatric and rehabilitation day programs in private
hospitals only.
Excess will apply for all overnight and day services in a public
hospital.
Excess will apply for all overnight and day services in a public
hospital.
Excess Bonus
N/A
N/A
Co-Payment
N/A
N/A
For the first 24 months:
For the first 24 months:
•Hip and knee replacement including revisions and resurfacing
procedures (except where they are required as a result of an
accident which occurs after the cover commenced)
•Hip and knee replacement including revisions and resurfacing
procedures (except where they are required as a result of an
accident which occurs after the cover commenced)
•Cataract and eye lens procedures
•Cataract and eye lens procedures
•Dialysis for chronic renal failure
•Dialysis for chronic renal failure
(Excess Waiver)
MINIMUM
Benefits
(Share room
minimum benefits)
•IVF and assisted reproductive services
•IVF and assisted reproductive services
•Bone marrow transplants
•Bone marrow transplants
•All psychiatric conditions (except eating disorders and post
natal depression)
•All psychiatric conditions (except eating disorders and post
natal depression)
•Surgical podiatry procedures
For the duration of this cover:
•Surgical podiatry procedures
Exclusions
(No benefits apply)
Waiting
Periods
For the duration of this cover:
For the duration of this cover:
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Cosmetic surgery that is not clinically required
•Cosmetic surgery that is not clinically required
•2 month initial, palliative care, psychiatric and rehabilitation
services
•2 month initial, palliative care, psychiatric and rehabilitation
services
•12 months pre-existing condition
•12 months pre-existing condition
•12 months pregnancy (including childbirth)
•12 months pregnancy (including childbirth)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only.
Excess applies to in-patients only.
Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services.
This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs.
Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List.
A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected]
20
Effective APRIL 2014
CORPORATE Hospital Covers at a Glance
Hospital
Cover
MINING AND RESOURCES
HEALTH COVER
Ultimate CORPORATE
Health Cover (Package)
ON SALE Product
ON SALE Product
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees
except for Minimum Benefit and Excluded services.
Members First & Network Hospitals: Cover for hospital
accommodation (including private room) and theatre fees
except for Minimum Benefit and Excluded services.
Public Hospitals: Shared room minimum benefit plus a fixed
benefit per day for a private overnight room. All other services
that are not excluded receive shared room minimum benefits.
Nil benefit for excluded services.
Public Hospitals: Shared room minimum benefit plus a fixed
benefit per day for a private overnight room. All other services
that are not excluded receive shared room minimum benefits.
Nil benefit for excluded services.
In addition this product covers laser eye procedures to correct
sight (excludes laser procedures involving lens implants). Only
at Bupa approved centres.
Ultimate Corporate Health Cover members charged a fixed
daily fee by any of our contracted fixed fee hospitals will be
reimbursed or have the fee paid directly to the hospital.
Excess
•Level 1 – Nil Excess
N/A
•Level 2 – $250 per hospital admission for adults
Excess payable on same day and public admissions.
Capped each calendar year at once per adult when amount has
been met in full.
The excess does not apply to any child dependant covered on
the membership.
The excess does not apply on admissions for services with a
minimum benefit or for approved hospital ambulatory programs
or psychiatric and rehabilitation day programs in private
hospitals only.
Excess will apply for all overnight and day services in a public
hospital.
Excess Bonus
N/A
N/A
Co-Payment
N/A
N/A
MINIMUM
Benefits
For the duration of this cover:
For the duration of this cover:
•Surgical podiatry procedures
•Surgical podiatry procedures
Exclusions
For the duration of this cover:
For the duration of this cover:
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Cosmetic surgery that is not clinically required
•Cosmetic surgery that is not clinically required
•2 month initial, palliative care, psychiatric and rehabilitation
services
•2 month initial, palliative care, psychiatric and rehabilitation
services
•12 months pre-existing condition
•12 months pre-existing condition
•12 months pregnancy (including childbirth)
•12 months pregnancy (including childbirth)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
•12 months laser eye correction (excludes lens implant for eye
correction)
(Excess Waiver)
(Share room
minimum benefits)
(No benefits apply)
Waiting
Periods
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only.
Excess applies to in-patients only.
Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services.
This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs.
Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List.
A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected]
21
Effective APRIL 2014
VISITORS Hospital Covers at a Glance
NON-WORKING VISA
This guide is for the use of hospital staff and providers only and does not contain all product information.
Please also note this guide is subject to change without notice.
Hospital
Cover
Advantage Visitors Cover
MID VISITORS COVER
OVERSEAS STUDENT HEALTH COVER/
ADVANTAGE OVERSEAS STUDENT
HEALTH COVER
ON SALE Product
OFF SALE Product
ON SALE Product
Cover for hospital accommodation
(including private room) and theatre
fees in Members First and most Network
hospitals except for minimum benefit and
excluded services.
Shared room benefits for hospital
accommodation in all public hospitals
only, except for excluded services.
Cover for hospital accommodation in
public hospitals, except for excluded and
minimum benefit services.
Cover for hospital accommodation
(including private room) and theatre
fees in Members First and most Network
hospitals except for minimum benefit and
excluded services.
Cover for hospital accommodation in
public hospitals, except for excluded and
minimum benefit services.
Excess
N/A
N/A
N/A
Co-Payment
N/A
N/A
N/A
For the period specified:
For the duration of this cover:
For the duration of this cover:
•2 years – Cataract and eye lens
procedures
• Surgical podiatry procedures
•Surgical podiatry procedures
For the duration of this cover:
For the duration of this cover:
For the duration of this cover
•Procedures not recognised by Medicare
or not approved by the Medical Services
Advisory Committee and experimental
treatment
• IVF and assisted reproductive services
•IVF and assisted reproductive services
• Cataract and eye lens procedures
•Procedures not recognised by Medicare
or not approved by the Medical Services
Advisory Committee and experimental
treatment
MINIMUM
Benefits
(Share room
benefits)
•2 years – Hip and knee replacements
including arthroplasty, revisions and
resurfacing procedures
For the duration of this cover:
•Surgical podiatry procedures
Exclusions
(No benefits apply)
•IVF and assisted reproductive services
(effective 1 June 2014) #
•Cosmetic surgery that is not clinically
required
#
embers who have served waiting periods will
M
continue to be covered for IVF and assisted
reproductive services until 31 December 2014.
Conditions apply, contact Bupa for eligibility.
• Hip and knee replacements including
arthroplasty, revisions and resurfacing
procedures
• Procedures not recognised by Medicare
or not approved by the Medical Services
Advisory Committee and experimental
treatment
•Cosmetic surgery that is not clinically
required
• All cosmetic surgery (including clinically
required)
• Sterilisation reversal
Waiting
Periods
•12 months pre-existing condition
• 12 months pre-existing condition
•12 months pregnancy (including
childbirth)
• 12 months pregnancy (including
childbirth)
•No waiting period for accidents
sustained after joining (if medical
advice sought within 72 hours)
• 12 months psychiatric and rehabilitation
• N o waiting period for accidents
sustained after joining (if medical
advice sought within 72 hours)
•2 month pre-existing condition
of a psychiatric nature (not applicable
to Advantage Overseas Student Health
Cover)
•12 months for all other pre-existing
conditions
•12 months pregnancy (including
childbirth)
•No waiting period for accidents
sustained after joining (if medical
advice sought within 72 hours)
Medical
Cover
Up to 100% of MBS fee (or the Gap
Scheme benefit if you’re a Gap Scheme
provider) for inpatient services.
Up to 100% of AMA Schedule fee (or
the Gap Scheme benefit if you’re a Gap
Scheme provider) for inpatient services.
Up to 100% MBS fee (or the Gap Scheme
benefit if you're a Gap Scheme provider)
for inpatient services.
Up to 100% of MBS fee as a hospital outpatient or by a doctor or specialist in
private practice anywhere in Australia.
Up to 100% of MBS fee as a hospital outpatient or by a doctor or specialist in
private practice anywhere in Australia.
Up to 100% MBS fee as a hospital outpatient or by a doctor or specialist in
private practice anywhere in Australia.
Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only.
Excess applies to in-patients only.
Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services.
This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs.
Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List.
A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected]
*Short Stay Education Cover was renamed Short Stay Visitors Cover effective 1 April 2014.
22
Effective APRIL 2014
VISITORS Hospital Covers at a Glance
Hospital
Cover
Overseas Visitors Cover
Premium Visitors Cover
OFF SALE Product
OFF SALE Product
Cover for hospital accommodation (including private room)
and theatre fees in Members First and most Network hospitals
except for minimum benefit and excluded services.
Cover for hospital accommodation (including private room)
and theatre fees in Members First and most Network hospitals
except for minimum benefit and excluded services.
Cover for hospital accommodation in public hospitals, except
for excluded and minimum benefit services.
Cover for hospital accommodation in public hospitals, except
for excluded and minimum benefit services.
Excess
N/A
N/A
Co-Payment
N/A
N/A
For the period specified:
For the period specified:
•12 months – Cardiac and cardiac-related services
•12 months – Cardiac and cardiac-related services
•12 months – Pregnancy (including childbirth)
•12 months – Pregnancy (including childbirth)
•2 years – Cataract and eye lens procedures
•2 years – Cataract and eye lens procedures
•2 years – Hip and knee replacements including arthroplasty,
revisions and resurfacing procedures
•2 years – Hip and knee replacements including arthroplasty,
revisions and resurfacing procedures
•2 years – Psychiatric services
•2 years – Psychiatric services
•2 years – Rehabilitation services
•2 years – Rehabilitation services
For the duration of this cover:
For the duration of this cover:
•Cosmetic surgery that is clinically required and is recognised
by Medicare
•Cosmetic surgery that is clinically required and is recognised
by Medicare
•Surgical podiatry procedures
•Surgical podiatry procedures
For the duration of this cover:
For the duration of this cover:
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•IVF and assisted reproductive services (effective 1 June 2014) #
•IVF and assisted reproductive services (effective 1 June 2014) #
•Cosmetic surgery that is not clinically required
•Cosmetic surgery that is not clinically required
MINIMUM
Benefits
(Share room
benefits)
EXCLUSIONS
(No benefits apply)
#
Waiting
Periods
Medical
Cover
embers who have served waiting periods will continue to be covered for
M
IVF and assisted reproductive services until 31 December 2014. Conditions
apply, contact Bupa for eligibility.
#
embers who have served waiting periods will continue to be covered for
M
IVF and assisted reproductive services until 31 December 2014. Conditions
apply, contact Bupa for eligibility.
•12 months pre-existing condition
•12 months pre-existing condition
•12 months pregnancy (including childbirth)
•12 months pregnancy (including childbirth)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
Up to 100% of MBS fee (or the Gap Scheme benefit if you’re
a Gap Scheme provider) for inpatient services.
Up to 100% of MBS fee (or the Gap Scheme benefit if you’re
a Gap Scheme provider) for inpatient services.
Up to 100% of MBS fee as a hospital out-patient or by a doctor
or specialist in private practice anywhere in Australia.
Up to 100% of MBS fee as a hospital out-patient or by a doctor
or specialist in private practice anywhere in Australia.
Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only.
Excess applies to in-patients only.
Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services.
This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs.
Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List.
A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected]
23
Effective APRIL 2014
VISITORS Hospital Covers at a Glance
Hospital
Cover
Excess
Short Stay VISITORS Cover
STANDARD VISITORS COVER
Top Visitors Cover
ON SALE Product
ON SALE Product
ON SALE Product
Cover for hospital accommodation
(including private room) and theatre
fees in Members First and most Network
hospitals except for minimum benefit and
excluded services.
Cover for hospital accommodation
(including private room) and theatre
fees in Members First and most Network
hospitals except for minimum benefit and
excluded services.
Cover for hospital accommodation
(including private room) and theatre
fees in Members First and most Network
hospitals except for minimum benefit and
excluded services.
Cover for hospital accommodation in
public hospitals, except for excluded and
minimum benefit services.
Cover for hospital accommodation for
public hospitals, except for excluded and
minimum benefit services.
Cover for hospital accommodation for
public hospitals, except for excluded and
minimum benefit services.
$250 per hospital admission (including
same day and public admissions).
N/A
Nil excess option or $500 per hospital
admission (including same day and public
admissions).
Capped each calendar year at once per
adult, when amount has been met in full.
Capped each calendar year at once per
adult, when amount has been met in full.
The excess does not apply on admissions
for services with a minimum benefit or for
approved hospital ambulatory programs
or psychiatric and rehabilitation day
programs in private hospitals only.
The excess does not apply to any child
dependant on the membership.
The excess does not apply on admissions
for services with a minimum benefit or for
approved hospital ambulatory programs
or psychiatric and rehabilitation day
programs in private hospitals only.
Excess will apply for all overnight and
day services in a public hospital.
Excess will apply for all overnight and
day services in a public hospital.
Co-Payment
MINIMUM
Benefits
(Share room
benefits)
EXCLUSIONS
(No benefits apply)
N/A
N/A
N/A
For the duration of this cover
For the duration of this cover:
For the duration of this cover:
•Surgical podiatry procedures
•Cardiac and cardiac related services
•Surgical podiatry procedures
•Surgical podiatry procedures
For the duration of this cover
For the duration of this cover:
For the duration of this cover:
•All pre-existing ailments, illnesses or
conditions
•Pregnancy (including childbirth)
•Pregnancy (including childbirth)
•Cataract and eye lens procedures
•Procedures not recognised by Medicare
or not approved by the Medical Services
Advisory Committee and experimental
treatment
•IVF and assisted reproductive services
•Cataract and eye lens procedures
•Hip and knee replacements including
arthroplasty, revisions and resurfacing
procedures
•Procedures not recognised by Medicare
or not approved by the Medical Services
Advisory Committee and experimental
treatment
•All cosmetic surgery (including clinically
required)
Waiting
Periods
•Hip and knee replacements including
arthroplasty, revisions and resurfacing
procedures
•Dialysis for chronic renal failure
•Procedures not recognised by Medicare
or not approved by the Medical Services
Advisory Committee and experimental
treatment
•Cosmetic surgery that is not clinically
required
#
embers who have served waiting periods will
M
continue to be covered for IVF and assisted
reproductive services until 31 December 2014.
Conditions apply, contact Bupa for eligibility.
•All cosmetic surgery (including clinically
required)
•Sterilisation reversal
•12 months pre-existing condition
•12 months pre-existing condition
•12 months rehabilitation services
•12 months psychiatric and rehabilitation
•12 months palliative care
•No waiting period for accidents
sustained after joining (if medical
advice sought within 72 hours)
•12 months pregnancy (including
childbirth)
•No waiting period for accidents
sustained after joining (if medical
advice sought within 72 hours)
Up to 100% MBS fee (or the Gap Scheme
benefit if you’re a Gap Scheme provider)
for inpatient services.
Up to 100% of MBS fee (or the Gap
Scheme benefit if you’re a Gap Scheme
provider) for inpatient services.
Up to 100% of MBS fee (or the Gap
Scheme benefit if you’re a Gap Scheme
provider) for inpatient services.
Up to 100% MBS fee as a hospital outpatient or by a doctor or specialist in
private practice anywhere in Australia.
Up to 100% of MBS fee as a hospital outpatient or by a doctor or specialist in
private practice anywhere in Australia.
Up to 100% of MBS fee as a hospital outpatient or by a doctor or specialist in
private practice anywhere in Australia.
Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only.
Excess applies to in-patients only.
Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services.
This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs.
Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List.
A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected]
24
•IVF and assisted reproductive services
(effective 1 June 2014) #
•12 months psychiatric services
•No waiting period for accidents
sustained after joining (if medical
advice sought within 72 hours)
Medical
Cover
•IVF and assisted reproductive services
Effective APRIL 2014
VISITORS Hospital Covers at a Glance
WORKING VISA
This guide is for the use of hospital staff and providers only and does not contain all product information.
Please also note this guide is subject to change without notice.
Hospital
Cover
Classic Visitors Cover
CORPORATE OVERSEAS Visitors Cover
ESSENTIAL VISITORS COVER/ESSENTIAL
PLUS VISITORS COVER
off SALE Product
OFF SALE Product
ON SALE PRODUCT
Cover for hospital accommodation
(including private room) and theatre
fees in Members First and most Network
hospitals except for minimum benefit and
excluded services.
Cover for hospital accommodation
(including private room) and theatre
fees in Members First and most Network
hospitals except for minimum benefit and
excluded services.
Cover for hospital accommodation in
public hospitals, except for excluded
and minimum benefit services.
Cover for hospital accommodation in
public hospitals, except for excluded
and minimum benefit services.
Shared room benefits for hospital
accommodation in all public hospitals
only except for excluded services.
Excess
N/A
N/A
N/A
Co-Payment
N/A
N/A
N/A
For the duration of this cover:
For the duration of this cover:
For the duration of this cover:
•Surgical podiatry procedures
•Surgical podiatry procedures
•Pregnancy (including childbirth)
MINIMUM
Benefits
(Share room
benefits)
EXCLUSIONS
(No benefits apply)
•Surgical podiatry procedures
For the duration of this cover:
For the duration of this cover:
For the duration of this cover:
•IVF and assisted reproductive services
•All pre-existing ailments, illnesses and
conditions
•Outpatient ante and post natal services
•Procedures not recognised by Medicare
or not approved by the Medical Services
Advisory Committee and experimental
treatment
•Cosmetic surgery that is not clinically
required
Waiting
Periods
•12 months pre-existing condition
•12 months pregnancy (including
childbirth)
•No waiting period for accidents
sustained after joining (if medical advice
sought within 72 hours)
Medical
Cover
•IVF and assisted reproductive services
•Outpatient psychiatric and psychology
benefits
•Procedures not recognised by Medicare
or not approved by the Medical Services
Advisory Committee and experimental
treatment
•Bone marrow transplants
•Cosmetic surgery that is not clinically
required
•Cosmetic surgery that is not clinically
required
•12 months pregnancy (including
childbirth)
•12 months pre-existing condition
•No waiting period for accidents
sustained after joining (if medical advice
sought within 72 hours)
•IVF and assisted reproductive services
•Organ transplants
•12 months pregnancy (including
childbirth)
•No waiting period for accidents
sustained after joining (if medical advice
sought within 72 hours)
Up to 100% of AMA Schedule fee (or
the Gap Scheme benefit if you’re a Gap
Scheme provider) for inpatient services.
Up to 100% of MBS fee (or the Gap
Scheme benefit if you’re a Gap Scheme
provider) for inpatient services.
Up to 100% of MBS fee (or the Gap
Scheme benefit if you’re a Gap Scheme
provider) for inpatient services.
Up to 100% of MBS fee as a hospital outpatient or by a doctor or specialist in
private practice anywhere in Australia.
Up to 100% of MBS fee as a hospital outpatient or by a doctor or specialist in
private practice anywhere in Australia.
Up to 100% of MBS fee as a hospital outpatient or by a doctor or specialist in
private practice anywhere in Australia.
Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only.
Excess applies to in-patients only.
Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services.
This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs.
Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List.
A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected]
25
Effective APRIL 2014
VISITORS Hospital Covers at a Glance
Hospital
Cover
Excess
EXECUTIVE Corporate Visitors Cover
GOLD VISITORS COVER/PLATINUM VISITORS COVER
OFF SALE Product
ON SALE Product
Cover for hospital accommodation (including private room)
and theatre fees in Members First and most Network hospitals
except for minimum benefit and excluded services.
Cover for hospital accommodation (including private room)
and theatre fees in Members First and most Network hospitals
except for minimum benefit and excluded services.
Cover for hospital accommodation in public hospitals, except
for excluded and minimum benefit services.
Cover for hospital accommodation in public hospitals, except
for excluded and minimum benefit services.
N/A
Nil excess option or $500 per hospital admission (including
same day and public admissions).
Capped each calendar year at once per adult, when amount has
been met in full.
The excess does not apply to any child dependant covered on
the membership.
The excess does not apply on admissions for services with a
minimum benefit or for approved hospital ambulatory programs
or psychiatric and rehabilitation day programs in private
hospitals only.
Excess will apply for all overnight and day services in a public
hospital.
Co-Payment
N/A
N/A
MINIMUM
Benefits
For the duration of this cover:
For the duration of this cover:
•Surgical podiatry procedures
•Surgical podiatry procedures
Exclusions
For the duration of this cover:
For the duration of this cover:
(Share room
benefits)
(No benefits apply)
Waiting
Periods
Medical
Cover
•IVF and assisted reproductive services
•IVF and assisted reproductive services
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Procedures not recognised by Medicare or not approved by
the Medical Services Advisory Committee and experimental
treatment
•Cosmetic surgery that is not clinically required
•Cosmetic surgery that is not clinically required
•12 months pre-existing condition
•12 months pre-existing condition
•12 months pregnancy (including childbirth)
•12 months pregnancy (including childbirth)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
Up to 100% of AMA Schedule fee (or the Gap Scheme benefit
if you’re a Gap Scheme provider) for inpatient services.
Up to 100% of AMA Schedule fee (or the Gap Scheme benefit
if you’re a Gap Scheme provider) for inpatient services.
Up to 150% of MBS fee as a hospital out-patient or by a doctor
or specialist in private practice anywhere in Australia.
Up to 150% of MBS fee as a hospital out-patient or by a doctor
or specialist in private practice anywhere in Australia.
Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only.
Excess applies to in-patients only.
Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services.
This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs.
Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List.
A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected]
26
Effective APRIL 2014
VISITORS Hospital Covers at a Glance
Hospital
Cover
SELECT VISITORS COVER
Ultimate Corporate
Visitors Cover
OFF SALE PRODUCT
ON SALE Product
Share room benefits for hospital accommodation in all public
hospitals only, except for excluded services.
Cover for hospital accommodation (including private room)
and theatre fees in Members First and most Network hospitals
except for minimum benefit and excluded services.
Cover for hospital accommodation for public hospitals, except
for excluded and minimum benefit services.
Ultimate Health Cover members will be reimbursed if charged
a fixed daily fee by any of our contracted fixed fee hospitals/
services or have the fee paid directly to the hospital.
Excess
N/A
N/A
Co-Payment
N/A
N/A
MINIMUM
Benefits
For the duration of this cover:
For the duration of this cover:
• Surgical podiatry procedures
•Surgical podiatry procedures
Exclusions
For the duration of this cover:
For the duration of this cover:
(Share room
benefits)
(No benefits apply)
• IVF and assisted reproductive services
•IVF and assisted reproductive services
• Procedures not recognised by Medicare or not approved
by the Medical Services Advisory Committee and
experimental treatment
•Procedures not recognised by Medicare or not approved
by the Medical Services Advisory Committee and
experimental treatment
• Cosmetic surgery that is not clinically required
•Cosmetic surgery that is not clinically required
• Outpatient medical fees
Waiting
Periods
Medical
Cover
• 12 months pre-existing condition
•12 months pre-existing condition
• 12 months pregnancy (including childbirth)
•12 months pregnancy (including childbirth)
• N o waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
•No waiting period for accidents sustained after joining
(if medical advice sought within 72 hours)
Up to 100% of AMA Schedule fee (or the Gap Scheme benefit
if you’re a Gap Scheme provider) for inpatient services.
100% of cost for inpatient services.
100% of cost as a hospital out-patient or by a doctor
or specialist in private practice anywhere in Australia.
Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only.
Excess applies to in-patients only.
Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services.
This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs.
Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List.
A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected]
27
Effective APRIL 2014
NEW Bupa membership cards
The following membership cards should be recognised at your hospital or practice.
When HBA, MBF and Mutual Community became Bupa, members would have received one of these cards.
However, some members may still present an HBA, MBF or Mutual Community card and some of these cards may contain
obsolete product names. To provide our members with affordable health insurance, after becoming Bupa we generally
did not send out additional new cards to reflect changes to product names. Refer within the guide for renamed products.
As long as the membership number is current and the member is financial, the old cards will work.
If members would like to order a new card they should contact us or log in to myBupa.
01 Jane Sample
02 Greg Sample
03 Audrey Sample
04 Brian Sample
Membership number:
32528749
Member since: 2009
01 Jane Sample
02 Greg Sample
03 Audrey Sample
04 Brian Sample
Top Hospital Cover
Platinum Extras
Membership number:
32528749
Member since: 2009
Ultimate Health Cover
Pharmacy Saver
NEW OSHC Bupa membership cards
The following membership cards should be recognised at your hospital or practice.
01 Mario Garabaldi
02 Betty Garabaldi
01 Mario Garabaldi
02 Betty Garabaldi
Student Number: 3082000
Education Faculty:
University of Ballarat
Membership number:
32528749
Overseas Student Health Cover
Cover valid until 01/01/2013
Membership number:
32528749
Overseas Student Health Cover
Cover valid until 01/01/2013
Please note: During 2014, Bupa will no longer be printing level of covers on membership cards. Bupa will not be reissuing
any member cards, so from this date there will be a combination of Bupa cards with or without level of cover featured.
28
Effective APRIL 2014
Bupa INTERNATIONAL membership cards
Bupa International members are covered by Bupa Australia hospital contracts.
Bupa International health insurance
Bupa Australia is part of the worldwide health and care specialists, BUPA.
Bupa International provides health insurance to expatriates living and working in other countries, including Australia.
Members with the following cards are covered by Bupa
International:
• Bupa Arabia
• Bupa Hong Kong
• Bupa Insurance Limited
• Bupa Insurance Services Limited
• Bupa Latin America
• Bupa Thailand
• IHI Bupa
• Max Bupa
• Sanitas (Bupa) Spain
• USA Medical Services Corporation
Bupa International offers the following products:
• Bupa International Gold with dental
• Bupa Worldwide Health options
• Corporate bespoke plans
• Company Gold Superior
• IHHP (International Health Hospital Plan)
• ISM (International Swiss Medical)
• Lifeline Classic
• Lifeline Essential
• Lifeline Gold
29
Effective APRIL 2014
Bupa INTERNATIONAL membership cards
The following international membership cards should be recognised at your hospital or practice.
30
Effective APRIL 2014
Pre-authorisation Hospital checks
for Bupa International members
A pre-authorisation hospital check for Bupa International
members is required via fax or email with the form
downloaded from the following website:
www.bupa-intl.com/partner/medical-provider-network
Alternatively you can call the Bupa International Helpline.
Please see below for details.
Whenever a patient requires day-case or inpatient treatment,
please contact us as per the above with the following
information:
• Medical records
• Symptoms
• Diagnosis
• Procedure
• Admission and discharge date
Contact information for Pre-Authorisation:
Bupa International
Tel: +44 1273 333911
Fax: +44 1273 866301
Email: [email protected]
ihi Bupa
Tel: +45 33 15 33 00
Fax: +45 33 32 25 60
Email: [email protected]
Note: Helpline operates: 24 / 7 / 365 days a year
For general enquiries to the Provider Services Department,
they may be contacted via:
[email protected]
On receipt of the above information, the request will be
reviewed and response given:
• If requested by telephone: immediate response
• If requested by email or fax: response within 72 hours
Please note that in case of an emergency admission always
contact the 24 hour helplines.
Hospital Services for Bupa International Members
Where a Bupa International member attends a Members First
or Network Hospital/Day Facility for a service Covered under
the Bupa Australia Agreement, the Bupa International member
should be billed under the terms and conditions of the Bupa
Australia Agreement.
Hospital Claims for Bupa International Members should be sent
to Hospital Claims, GPO Box 990, Adelaide, SA, 5001.
If you need to pre-authorise treatment for a member of Bupa
Latin America, please contact USA Medical Services on:
Tel: +1 305 275 1500, for USA
Tel: +1 800 726 1203, free of charge from USA
31
FOR MORE INFORMATION:
Hospital use
To ensure a timely response to your enquiry, please contact
the correct department for assistance.
Pre-Admission patient eligibility checks
To verify a membership, hospitals can check Bupa Australia
entitlement via the online eligibility system through Eclipse.
This system is available 24/7.
Membership Checking — https://eclipse.civica.com.au/ECFWeb
If this system is unavailable due to system issues at Bupa
Australia or Medicare then EMERGENCY checks can be done
via telephone to Contact Centre on 134 135 (Current hours
8.00am to 8.00pm Mon to Fri, Sat 9.00am to 1.00pm EST).
Post-Admission hospital claims enquiries
Department: Hospital Claims Department
For: Queries regarding a benefit received following hospitalisation
Email: [email protected]
Tel: 1300 663 590
Fax: 1300 303 548
Hours availability: 9.15am — 5.15pm, EST Monday to Friday
Drs Rooms use
For queries regarding payment of a medical claim please ring:
1300 367 877
Email: [email protected]
Bupa Australia Pty Ltd
ABN 81 000 057 590
Effective April 2014
10248-04-14P